Celebrating the Survivors Spirit

Kick Up Your Heels Relay Event

**All entries MUST BE POSTMARKED by: April 6, 2012**

Date of Event: April 14, 2012 at 9:00 am

Registration at Couch Park, Stillwater, OK

Registration starts at 8:00 am
I, by submitting this form acknowledge that participation in this relay is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I also know that there will be a possibility of traffic on the course. I assume the risk of running in traffic. I also assume any and all other risks associated with participating in this event including, but not limited to falls, contact with other participants, the effects of the weather, medical conditions related to heat or hydration, and the condition of roads, all such risks being known and appreciated by me. Furthermore I agree to yield to all emergency vehicles. I also am fully aware that wheels of any kind except baby strollers and competitive wheelchairs, animals and headphones are strictly prohibited and I agree not to have them on the course. Furthermore, I agree not to go back onto the course after finishing. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and to waive and release and discharge Wings of Hope Family Crisis Services, any and all race sponsors, race officials, volunteers, local and state police, and all municipalities including any and all of their agents, employees, assigns or anyone acting for or on their behalf from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The BELOW SIGNED further grants full permission to sponsors and or agents authorized by them to use any photographs, video tapes, motion pictures, recordings or any other record of this event for any purpose. Application for minor accepted only with a parent or guardian signature.
Signature Date Month Day Year

We accept checks, cashiers checks and money orders. Make checks payable to: Wings of Hope Family Crisis Services.
Name on credit card (if paying by credit card) Credit card number Credit Card Type CVV2/Card code
Expiration date

CC. billing zip/postal code Month Year

Signature

Team Captain
First Name Mailing Address State Email Zip Code Country (if not U.S.) ( MI Last Name City Phone ) Gender M F

Age
On race day

Month
Date of Birth

Day

Year

Shirt Size
Youth

Shoe Size M L
Adult

M L

XL

2XL

Team Member 1
First Name Age
On race day

MI Month
Date of Birth

Last Name Shirt Size

Youth

Gender M F Shoe Size M L

Adult

Day

Year

M L

XL

2XL

Team Member 2
First Name Age
On race day

MI Month
Date of Birth

Last Name Shirt Size

Youth

Gender M F Shoe Size M L

Adult

Day

Year

M L

XL

2XL

Team Member 3
First Name Age
On race day

MI Month
Date of Birth

Last Name Shirt Size

Youth

Gender M F Shoe Size M L

Adult

Day

Year

M L

XL

2XL

Mail Entries to: Spirit Run Entry 3800 N. Washington Stillwater, OK 74075 Phone: (405) 372-9922 Fax: (405) 624-2408

Entry Fees: Fees are per Person. Relay Events - Individual - $15 Team - $40